CPT code 23931 is for the incision and drainage of an upper arm or elbow bursa, a procedure to relieve inflammation or infection.
CPT code 23931 is used to describe the procedure of incision and drainage (I&D) of an upper arm or elbow bursa. This code is utilized when a healthcare provider performs a surgical procedure to make an incision in the bursa—a small fluid-filled sac that reduces friction between tissues of the body—and drains any accumulated fluid, often due to infection or inflammation. This helps alleviate pain and reduce swelling in the affected area.
For the CPT code 23931 (Incision and drainage of upper arm or elbow bursa), the following modifiers may be applicable:
1. Modifier 22 (Increased Procedural Services): Used when the work required to perform the procedure is substantially greater than typically required. This could be due to complications or other factors that make the procedure more complex.
2. Modifier 50 (Bilateral Procedure): Used if the procedure is performed on both sides of the body during the same operative session.
3. Modifier 51 (Multiple Procedures): Applied when multiple procedures are performed during the same surgical session. This helps in indicating that more than one procedure was carried out.
4. Modifier 59 (Distinct Procedural Service): Used to indicate that a procedure or service was distinct or independent from other services performed on the same day. This is often used to bypass National Correct Coding Initiative (NCCI) edits.
5. Modifier LT (Left Side): Indicates that the procedure was performed on the left side of the body.
6. Modifier RT (Right Side): Indicates that the procedure was performed on the right side of the body.
7. Modifier 76 (Repeat Procedure by Same Physician): Used when the same procedure is repeated by the same physician on the same day.
8. Modifier 77 (Repeat Procedure by Another Physician): Used when the same procedure is repeated by a different physician on the same day.
9. Modifier 78 (Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period): Indicates that the patient required a return to the operating room for a related procedure during the postoperative period.
10. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Used when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
11. Modifier 80 (Assistant Surgeon): Indicates that an assistant surgeon was necessary for the procedure.
12. Modifier 81 (Minimum Assistant Surgeon): Used when a minimum assistant surgeon was required for the procedure.
13. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): Indicates that an assistant surgeon was necessary because a qualified resident surgeon was not available.
14. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery): Used when a non-physician provider assists in the surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
CPT code 23931 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and the corresponding payment rates. However, it is essential to verify the reimbursement status with your local Medicare Administrative Contractor (MAC), as they are responsible for processing Medicare claims and can provide detailed information on any regional variations or additional requirements that may apply. Always consult the MPFS and your MAC to ensure accurate and up-to-date information regarding the reimbursement of CPT code 23931.
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